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(5) Walking Speed is Improved in Nonsurgical Back Pain Patients Treated with 10kHz Spinal Cord Stimulation

Friday, June 13, 2025
4:30 PM - 5:10 PM ET
Location: Sky View
Introduction: Chronic low back pain (LBP) negatively impacts quality of life and ability to do activities of daily living, so functional outcomes are important when evaluating therapies.(1,2,3,4,5) Because patient reported outcomes (PRO) can be influenced by multiple psychological factors, performance-based functional tests may provide a more comprehensive understanding of a patient’s physical function.(6) Walking speed has been named a “vital sign” and has been shown to be related to all-cause mortality(7). The ‘50ft walk at fastest speed’ test (50ft-Walk) has been validated in patients with LBP(8). Objective is to analyze results of the 50ft-Walk test, and the walk item on the Oswestry Disability Index (ODI4) for patients receiving 10kHz spinal cord stimulation(SCS) versus conventional medical management(CMM) as part of a randomized controlled trial evaluating 10kHz-SCS for the treatment of nonsurgical refractory back pain (NSRBP-RCT).(9)

Methods: The NRSBP-RCT enrolled 159 patients who were randomized 1:1 to either CMM or 10kHz-SCS with a crossover at 6-months(10). The 50ft-Walk test, and PROs, including ODI were administered at baseline and follow-ups to 24M.10 The 50ft-Walk test involves 4 repeated, averaged timed trials of a 50ft walk with patients instructed to walk at their fastest speed. Analysis included 50ft-Walk outcome and ODI4 between randomized groups and in all implanted (including crossovers) to 24M. In addition, the outcome for Slower patients (> median 50ft-Walk time) versus Faster (< median) was compared.

Results: The baseline characteristics of the two groups are shown in Table 1. The 10kHz-SCS group significantly reduced time to walk 50ft while the CMM group did not (p < 0.001, Figure 1). Analyzing all implanted patients (n=125 including crossovers), the in 50ft-Walk time significantly reduced (p < 0.001), in addition the ODI4 showed significant improvement (p < 0.001, chi-square test, Figure 2). When a subgroup of Slower patients was analyzed at 24M, mean reduction in walking time was 3.8 sec, or 1.3X the minimum clinically important difference of 3 secs11 (Figure 3). The point change in ODI4 was positively correlated with the 50ft-Walk test (R=0.436, p=0.002).

Conclusion: Non-surgical back pain patients treated with 10kHz-SCS demonstrated a clinically significant improvement in walking speed, an important functional vital sign(11). Future research may help elucidate if the improvement in walking is driven by pain relief only or if motor and sensory improvements contribute. The low positive correlation between the performance-based outcome (50ft-Walk) and the PRO (ODI) supports the additive value of a performance-based test to evaluate function more fully in SCS treated patients.